Human skin aging occurs at different rates, with some individuals showing fewer signs of aging than others, despite variations in environmental conditions. Current corrective measures mainly focus on smoothing the surface microtexture of the skin, decreasing perceived pigmentation irregularities, and reducing the appearance of lines and wrinkles. For deeper lines, wrinkles, and macro folds of the skin, the use of fillers has come into common use. The upper and lower thirds of the face, along with the neck, have received the most attention, with procedures now being developed for the midfacial areas. Injectable fillers and stimulators are used mainly to replace volume in an aging face, commonly with autologous fat transfer and grafting. Enrichment of grafts for adipocyte-derived stem cells is now seen as a step toward better long-term success; however, given their multipotent nature, a certain degree of caution may be needed in attempting to stimulate differentiation for enhancement of adipocyte number and lipid accumulation.
In addition to filling voids in the face, a comprehensive anti-aging approach can include resurfacing with chemicals, lasers, and microdermabrasion, as well as stimulating the restructuring of the extracellular matrix with topical active ingredients and energy sources such as thermal, light, ultrasound and radiofrequencies. Methods developed to document the aging face primarily focus on the shape, color and texture of the facial skin and its thickness. However, one aspect of aging facial skin remaining to be adequately targeted is pan-facial subcutis lipoatrophy (FIG. 1), or the loss of bulking supportive fat lying beneath the dermis in general.